Decision making to discharge patients from airborne infection isolation rooms: The role of a single GeneXpert MTB/RIF strategy in Brazil

Abstract

Objective:Tuberculosis (TB) transmission in healthcare facilities is still a concern in low-income countries, where airborne isolation rooms are scarce due to high costs. We evaluated the use of single GeneXpert MTB/RIF, the molecular Mycobacterium tuberculosis (MTB) DNA and resistance to rifampicin (RIF) test, as an accurate and faster alternative to the current criteria of 3 negative acid-fast bacilli (AFB) smears to remove patients from airborne isolation.Methods:In this real-world investigation, we evaluated the impact of a single GeneXpert MTB/RIF on the decision making for discharging patients from respiratory isolation. We enrolled patients with suspected pulmonary TB in a public hospital that provides care for high-complexity patients in Brazil. We studied the performance, costs, and time saved comparing the GeneXpert MTB/RIF with AFB smears.Results:We enrolled 644 patients in 3 groups based on the number of AFB smears performed (1, 2, and 3, respectively) on respiratory specimens. GeneXpert MTB/RIF demonstrated good performance compared to AFB smear to rule out TB in all groups. The negative predictive value for AFB smear was 94% (95% confidence interval [CI], 0.90–0.97) and 98% (95% CIs, 0.94–0.99) for GeneXpert MTB/RIF in G3. The isolation discharge based on 3 AFB smears took 84 hours compared to 24 hours with GeneXpert MTB/RIF, which represents 560 patient-days saved in the isolation rooms.Conclusion:A single GeneXpert MTB/RIF is a fast and strong predictor for TB absence in a high-complexity hospital, which is quite similar to results obtained in recent studies in low-burden settings. This molecular test may also increase patient rotation through isolation rooms, with a positive impact in the emergency room and infectious diseases wards.

Performance Comparison of GeneXpert MTB/RIF, Gene Chip Technology, and Modified Roche Culture Method in Detecting Mycobacterium tuberculosis and Drug Susceptibility in Sputum

“…Early detection, diagnosis, and treatment play an important role in the effective control of tuberculosis transmission, with a high proportion of active tuberculosis being smearnegative tuberculosis. It has been reported in the research of Sah et al and Menon et al [6,7] that the GeneXpert MTB/ RIF has a positive rate of about 28-41% in detecting smearnegative pulmonary TB samples, consistent with the results of this study. is indicates that the GeneXpert MTB/RIF has high performance in clinical detection of smear-negative TB samples.…”

Hospital Practices for Respiratory Isolation for Patients With Suspected Tuberculosis and Potential Application of Prediction Models

“…The number of prediction models available for infection control committees to choose from will likely create heterogeneity among individual hospitals’ guidelines. The Xpert MTB-RIF assay (Xpert Ultra, Cepheid, Sunnyvale, CA, USA) can both identify cases of TB and rifampin resistance in several hours and may decrease reliance on sputum AFB staining and cultures [ 28 , 29 ]. However, it is still lacking widespread use due to cost, which is a hurdle for developing countries that may not be able to afford it, and in developed countries with a low incidence of TB.…”